Claim by Progressive Northern Insurance Company A/S/O John Klauer Copyrighted
April 15, 2024
City of Dubuque Consent Items # 02.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Cummer Masonry Inc. forvehicle damage; Progressive Northern
I nsurance Company A/S/O J ohn Klauer for vehicle damage; Cassidy
Loffa for vehicle damage.
SUGGESTED Suggested Disposition: Receive and File; Referto CityAttorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by Cummer Masonry Inc. Supporting Documentation
Progressive Northern Insurance Company A/S/O John Supporting Documentation
Klauer
Claim by Cassidy Loffa Supporting Documentation
mvm
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CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
This written report constitutes your claim against the City of Dubuque, lowa. You should
complete this form in full and attach any additional information that supports your claim.
The Claim must be filed with the City Clerk at City Hall, 50 W. 13`h St., Dubuque, IA 52001. It
will then be referred by the Gity Council to the appropriate department for investigation.
Once that investigation is completed, a report and recommendation will be submitted to the
City Council. You will be provided with a copy of that report and recommendation.
THE FINAL DECISION ON ALL CLAIMS IS MADE BY THE CITY COUNCIL. NO EMPLOYEE OF
THE CITY OF DUBUQUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TO YOU
AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID.
�. Nafil@ Of Clalf'Tlallt: Progressive Northern Insurance Company A1S/0 KLAUER, JOHN
2. Address: Po eox easss
City: cleveland State: oH Zip: aato�
3. Telephone Number: a��-a�a=otss
4. Date of Incident: ovzoizaza
5. Time of Incident: a:oa ann cr
6. Location of Incident (Be specific): w�otn st a�d�oo�st oUbuque, ia
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give
full details upon which you base your ciaim. If a City employee was involved, give the
employee's name.)
Our insured Gvas travelina at W 10th St and Locust Dubuaue. IA when a citv police vehicle oqerated bv Brant Dustin failed to
maintain proper lookout and yield the right of way,ran the red light at the intersection and struck our insured's vehicle.We are
seeking reimbursement for our insured's vehicle damages.
8. What were weather conditions like?
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
� Palice Agency: DUBUQUE PD Police Report#:2024-000518
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
N!A
i
12. Was any damage done to property? (If so, describe praperty and the extent of
damages. Attach estimates of damages or descr[be basis for ascertaining extent of
damage,)
2013 CHEVROI.ET EQUINOX-FRONT-TOTAL LOSS
13. What other damages do you claim, if ar�y? ��A
�4. Have you been compensated fior any part or all of your claim hy any insuranc�
company? (If so, give name and address of insurance company and amour�t paid.}
Progressive Narthern Insurance Company PO Box 94639 Cleveland, OH 441 D1
�5. What amount do you claim from the City of Dubuque?
$12,111.21
�
16. Why do you claim the City of Dubuque is responsible?
A ci olice vehicle o erated b Brant Dustin failed to maintain ro er lookout and ield the ri ht of wa ran the red li ht at the
intersection and struck our insured's vehicle.
17. Ha�e you made any claim against anyone else for damages as a result of this incident?
{Ifi yes, give name and address.)
NIA
18. If the answer fio Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
Dated at Dubuque, lowa this �� day of /��7tr � � , 202..`�.
f-���,"" (Signafure)
` Progressive Northern Insurance Company
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